PT - JOURNAL ARTICLE
AU - Bachur, Richard G.
AU - Monuteaux, Michael C.
AU - Neuman, Mark I.
TI - A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department
AID - 10.1542/peds.2014-2432
DP - 2015 Feb 01
TA - Pediatrics
PG - 232--238
VI - 135
IP - 2
4099 - http://pediatrics.aappublications.org/content/135/2/232.short
4100 - http://pediatrics.aappublications.org/content/135/2/232.full
SO - Pediatrics2015 Feb 01; 135
AB - BACKGROUND AND OBJECTIVES: Migraine headache is a common pediatric complaint among emergency department (ED) patients. There are limited trials on abortive therapies in the ED. The objective of this study was to apply a comparative effectiveness approach to investigate acute medication regimens for the prevention of ED revisits.METHODS: Retrospective study using administrative data (Pediatric Health Information System) from 35 pediatric EDs (2009–2012). Children aged 7 to 18 years with a principal diagnosis of migraine headache were studied. The primary outcome was a revisit to the ED within 3 days for discharged patients. The primary analysis compared the treatment regimens and individual medications on the risk for revisit.RESULTS: The study identified 32 124 children with migraine; 27 317 (85%) were discharged, and 5.5% had a return ED visit within 3 days. At the index visit, the most common medications included nonopioid analgesics (66%), dopamine antagonists (50%), diphenhydramine (33%), and ondansetron (21%). Triptans and opiate medications were administered infrequently (3% each). Children receiving metoclopramide had a 31% increased odds for an ED revisit within 3 days compared with prochlorperazine. Diphenhydramine with dopamine antagonists was associated with 27% increased odds of an ED revisit compared with dopamine antagonists alone. Children receiving ondansetron had similar revisit rates to those receiving dopamine antagonists.CONCLUSIONS: The majority of children with migraines are successfully discharged from the ED and only 1 in 18 required a revisit within 3 days. Prochlorperazine appears to be superior to metoclopramide in preventing a revisit, and diphenhydramine use is associated with increased rates of return.